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Does attendance drive academic performance? Or is it the other way around?
Student Attendance and Academic Performance in Undergraduate Obstetrics/Gynecology Clinical Rotations Deane RP et al. JAMA 2013; 310 (21): 2282-2288.
Reviewed by Sharon Sholiton

What was the study question?
Does medical student attendance at clinical and tutorial-based activities correlate with performance on end of year exams?

How was the study done?
All students completing a required 8 week clerkship in OB/Gyn at the University of Dublin (2011-12) were enrolled in this prospective cohort study. Students were strongly encouraged to attend 64 activities during the rotation, both clinical shifts and small group educational sessions (but attendance was not mandatory). Students were required to obtain supervisors' signatures in paper logbooks at each activity. Percent attendance was compared to student performance on year-end exams, which included an 11 station OSCE, a written exam, and an oral case-based exam.

What were the results?
Mean attendance for the 147 students was 89% (range 39 - 100%). A positive correlation was found between total attendance (and clinical and tutorial-based attendance, when assessed independently) and overall exam score (r=0.59; P < .001). "Distinction" grades were found only among students who had 80% attendance or higher. Failure rates were higher among students who attended activities less often.

What are the implications of these findings?
The high overall attendance rate in this study implies that medical students generally value attendance at activities within clinical rotations. Though this study identified a relationship between attendance and performance, it is hard to know whether this is causal or simply descriptive, as poor attendance may reflect weak academic skills, poor professionalism, or other factors which impact academic performance. The results may also be difficult to generalize to other institutions, where student attendance is more closely monitored. Further study is required to examine the factors underlying poor attendance; if a causal relationship can be identified between attendance and subsequent academic performance, efforts to target poor attenders at risk for becoming poor performers should be implemented.

Editor's note: What is most interesting about this study is its conclusions: What drives what? Does good attendance lead to better academic performance? Or, is it that highly performing students are inherently more motivated to attend? (SLB).

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